The journal Patient Education and Counseling recently published an exciting study entitled “The Impact of Health and Wellness Coaching (HWC) on Patient-Important Outcomes in Chronic Illness: A Systematic Review and Meta-Analysis." The study was conducted by a Mayo Clinic team.
Meta-analysis allows for statistically combining results of many unifocal (e.g., HWC) experimental studies to provide broad conclusions and recommendations. Meta-analysis is often the most trusted form of evidence in policy decision-making and is typically considered the pinnacle of scientific topic review.
WHAT and HOW: The study’s purpose was to determine the effects of HWC programs on quality of life (QoL), self-efficacy (SE), depression, and anxiety in chronically ill patients. Chronically ill was defined as any condition limiting self-care for more than 12 months. The authors only used randomized and controlled trials (RCTs), which are considered the most rigorous and powerfully designed experimental studies. Keep in mind, to be included in this review, a study had to be an HWC RCT in chronically ill patients measuring QoL, SE, depression, and/or anxiety. In the end, they selected and analyzed 30 RCTs from the 1337 HWC articles returned by their electronic search of the literature from 2005 – 2023. The 30 retained studies had over 8600 participants that were included in the meta-analysis.
FINDINGS: The meta-analyses revealed that HWC had a beneficial impact on QoL, SE, and depression. Each outcome improved at a different time point (e.g., at 3, 6, or 12 months) relative to starting a coaching intervention. Only anxiety was not found to improve after coaching. QoL, SE, and depression were measured in 14, 13, and 15 studies, respectively, while anxiety was measured in only 7 studies.
MAIN POINTS: HWC intervention is beneficial for chronically ill patients and can likely improve QoL, SE, and depressive symptoms. It was difficult to determine how long the HWC effects persisted and whether booster sessions were needed because reviewed studies generally did not have adequate follow-up measures after HWC sessions stopped. Successful coaching programs attended to aspects of the Theory of Patient Capacity (TPC). Typically, three TPC constructs were addressed in HWC studies that reported beneficial findings – more on TPC below.
CONCLUDING CONSIDERATIONS: The authors cited many limitations in the literature they reviewed. They called for stronger study designs, standardization of outcome measures, and longer follow-up periods.
OUR COMMENTARY: Given the design of this review and meta-analysis, it is difficult to say anything about the sustainability of HWC intervention. This study specifically used papers that measured QoL, SE, depression, and anxiety but did not seek to find papers that emphasized long-term follow-up outcome measures. If you are interested in the potential long-term effects of coaching, then check out a study that was designed to address this question (Ahmann 2023). We recently reviewed Ahmann et al. 2 in this column and concluded there are sustained beneficial effects of HWC beyond the coaching period.
An interesting concept discussed by authors of this study involved framing HWC treatments in terms of the TPC constructs (Biography, Resources, Environment, Work, and Social Functioning – BREWS). According to this theory, patients draw on these capacities they may possess to deal with the challenges of their treatment. It may be beneficial to plan HWC programs to address these capacities. The figure below provides a graphic of patient capacities. If you want to learn more about the TPC, then start with the reference cited below3.
CONCLUSIONS: We now have further evidence of a beneficial effect of HWC on psychometric outcomes such as life quality and self-efficacy in a patient population. These are such important self-reported constructs. Consider, now, that we can be comfortable saying that participation in several months of coaching can positively impact the quality of one’s life – a strong statement even when taken in isolation from the other beneficial HWC effects reported here. The meta-analysis described here also verifies the effectiveness of HWC for addressing depressive symptoms, though, surprisingly, the papers analyzed did not support a similar impact on anxiety. A concept like the Theory of Patient Capacity might inform your coaching. Consider looking into it, especially if you work with patients with self-treatment limitations.
REFERENCES
Boehmer KR, Álvarez-Villalobos NA, Barakat S, de Leon-Gutierrez H, Ruiz-Hernandez FG, Elizondo-Omaña GG, Vaquera-Alfaro H, Ahn S, Spencer-Bonilla G, Gionfriddo MR, Millan-Alanis JM, Abdelrahim M, Prokop LJ, Murad MH, Wang Z. The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis. Patient Educ Couns. 2023 Sep 15;117:107975. doi: 10.1016/j.pec.2023.107975.
Ahmann E, Saviet M, Conboy L, Smith K, Iachini B, DeMartin R. Health and Wellness Coaching and Sustained Gains: A Rapid Systematic Review. American Journal of Lifestyle Medicine. 2023;0(0).
Boehmer, K.R., Gionfriddo, M.R., Rodriguez-Gutierrez, R. et al. Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis. BMC Fam Pract 17, 127 (2016). https://doi.org/10.1186/s12875-016-0525-9